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`Size is not everything`: the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT)

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme inhibitor or calcium channel blocker versus diuretic. The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT)

University of Glasgow, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, G11 6NT, UK, University of Glasgow, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, G11 6NT, UK

ALLHAT, the largest ever antihypertensiv e trial, compared cardiac outcomes in 42,418 high-risk individuals with mild-to-moderate hypertension, including 36% with diabetes, randomised to: 1) the thiazide-type diuretic, chlorthalidone; or 2) the ACE inhibitor, lisinopril; or 3) the calcium channel blocker, amlodipine. No differences between the groups were observed for the primary outcome coronary heart disease (CHD) but chlorthalidone was superior in preventing some cardiovascular disease events. Since diuretics are less expensive, it might be inferred that these drugs should be the preferred first-line antihypertensive therapy. However, the design and conduct of ALLHAT make interpretation of the results difficult. Despite its size, ALLHAT has few practical implications for management of hypertension.

Key Words: ACE inhibitor • amlodipine • calcium channel blocker • chlorthalidone • lisinopril • thiazide-type diuretic.

The British Journal of Diabetes & Vascular Disease, Vol. 3, No. 4, 263-267 (2003)
DOI: 10.1177/14746514030030040501


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